When you think about it, every day is Halloween for many musicians. They wear costumes onstage, often assuming different personas, and are generally the life of the party. But there's one thing that can make performing live a fright fest all on its own: stage fright.

For many artists, stage fright is a serious ailment, whether they're performing on the intimate stage of a club or theater, or surrounded by thousands of seats in an arena or stadium. They are tasked with remembering lyrics, chords and other cues while lights, pyrotechnics and other distractions flash around them. Many artists have confessed to experiencing stage fright, including Adele, Ozzy Osbourne, Luciano Pavarotti, Katy Perry, Rihanna, Rod Stewart, and Barbra Streisand.

"To say that I suffer from pre-show nerves is like saying that when you get hit by an atom bomb it hurts a bit,"Osbourne wrote in his 2010 autobiography, I Am Ozzy.

Adele has admitted she vomits before nearly ever concert due to stage fright.

"I'm scared of audiences," the GRAMMY winner revealed in a 2011 interview with Rolling Stone. "I get s***ty scared. One show in Amsterdam, I was so nervous I escaped out the fire exit. I've thrown up a couple of times. Once in Brussels, I projectile-vomited on someone."

According to the Anxiety and Depression Association of America, the fear of performance can place a heavy toll on an individual's confidence and self-esteem.

"Many, including seasoned professional performers, suffer in silent terror," the organization states on its website. "And because they feel embarrassed, people try to keep their fear a secret, even from a spouse or other close family members or friends."

A case-in-point for the perils of stage fright is guitar legend Eddie Van Halen, who for years hid his struggles with performance anxiety.

"When I started playing in front of people, I'd get so damn nervous," Van Halen revealed in a recent interview with Esquire. To help quell his nerves, one day Van Halen sampled a pre-performance cigarette and some alcohol. "For so long, it really did work," he said.

For Harold Owens, Senior Director of MusiCares, The Recording Academy's health and human services organization, the Van Halen story has a familiar ring. With nearly 25 years of experience in addiction recovery, Owens has seen firsthand the anguish stage fright can cause, and notes that entertainers seldom discuss the problem while in the grip of their addiction.

"It's after they get sober — that's when the stage fright kicks in," says Owens. "I've heard people say repeatedly, 'I've never played sober.' It's a huge issue. We have support groups to address what it's like to [perform] your first [sober] gig."

Stage fright is a phobia that produces a symphony of coordinated biological reactions. Muscles contract, priming the body with bursts of energy. Blood vessels in the extremities constrict, resulting in tingling and numbness. an increase in heart rate produces sweat. Stage fright is the body's natural alarm response to emergency situations. But why do so many entertainers respond to performing as they would an emergency situation?

"When you think of little kids in moderately normal homes, they love performing — you can't stop them," Hilts says. "Then, some experience stomps that enthusiasm out of people. Some might have grown up in an environment where there was a lot of criticism, or maybe they were encouraged to be quiet."

To treat stage fright, some doctors prescribe "beta blocker" medications that close off the receptors responsible for our natural "fight or flight" response. Though these medications have been approved by the Food and Drug Administration, some anxiety specialists such as Hilts favor a more natural approach.

"In my experience, pharmaceuticals that block fear also take a big chunk out of joy," she says.

Hilts' preferred method is to extensively interview clients to get to the root of their performance fear, then apply counseling intervention techniques to help break the connection between the client's past trauma and their current behavior. She says there are simple things performers can do to help ensure a more anxiety-free performance experience, including frequent rehearsals, and adds that there's nothing wrong with performers confessing their vulnerability onstage.

"A lot of times you can release emotional discomfort by just cracking a joke about being nervous," she says. "All the people in the audience are going to connect with you for having the courage to do something that would personally scare the pants off of them."

For Hilts, it all comes down to conquering demons and enlisting the crowd as an ally. "The audience really wants you to be successful," she says.

Perhaps the Band said it best on their 1970 song, "Stage Fright": "Your brow is sweatin' and your mouth gets dry … the moment of truth is right at hand."

(Bruce Britt is an award-winning journalist and essayist whose work has appeared inThe Washington Post,USA Today,San Francisco Chronicle,Billboard, and other publications. He lives in Los Angeles.)

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